Archived: Harriets

We considered our inspection findings to answer questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found.

Is the service safe?

During our visit to the home we spent time observing staff supporting some of the people that used this service. We saw very good examples of staff supporting people with their care needs, particularly when using equipment to help people with their mobility. Assistance was given promptly, appropriately and safely. Staff took time to explain the process to people who may have been anxious about the use of this equipment.

Records about end of life care had received some review and update. They did not include information relating to the decision making processes and it was impossible to confirm whether these arrangements had been made with the person's consent and in their best interests.

We spoke with the manager about their responsibilities and the requirements of the Mental Capacity Act 2005. The manager told us that they were aware of the recent changes and the High Court judgements.

We found that the home was not clean and had not been appropriately maintained. This compromised the health, safety and welfare of people who used this service.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage them safely.

Is the service effective?

We found that care plans for the management of medicines and associated medical conditions had been reviewed. However, we also found that they were inadequate and not always reviewed promptly. This meant that staff did not always have clear guidance available to them to make sure that people received appropriate care.

We found that people had received assessments of their care and support needs. Information had been transferred into care plans but these did not contain sufficient detail, particularly where people needed help with specialist medical conditions, behaviours or nutrition.

We spoke to staff on duty during our visit. They told us that care plans had been reviewed and re-written by staff from outside of Harriets Care Home. They told us that they had been asked about service user's care needs by the people who were reviewing the care plans because they 'didn't know the service users.'

We looked at the staff training matrix and spoke to the managers about the staff training programme. We found that staff had not been provided with sufficient training to enable them to meet people's needs in a safe and consistent manner.

Is the service caring?

We spoke to people who used the service. They told us that they were 'Happy with the care' and 'Couldn't fault the staff.' We did not receive any complaints from people who used the service or their visitors during our inspection of Harriets Care Home.

We observed that staff were caring, attentive and treated people with respect. We heard staff explaining procedures to people during moving and handling transfers and checking that people had everything they needed to hand. We saw staff providing people with encouragement to support their independence. This could have been improved upon at meal times to make sure people ate and drank sufficient amounts.

Care plans and risk assessments had undergone a review process but we found that there were gaps in the information recorded. This meant that people may not have always received safe and appropriate care and support. There was some evidence of people having their nutritional intake and body weight monitored. More work was needed with this aspect of people's care needs to help ensure people received appropriate support with their nutritional requirements, including the involvement of medical professionals such as the GP and dietician.

Is the service responsive?

We looked at a sample of care plans belonging to people who used this service. We noted that care plans had undergone some element of review and update. We found that mental capacity assessments had started to be completed and we found that where possible people were enabled to make decisions on their own. The review and update of care plans had been undertaken by managers from other services operated by the provider, Roseberry Care Centres UK Limited.

The sample of care plans we looked at did not accurately reflect people's care and support needs. For example there were gaps in management plans, particularly relating to behaviours, medical conditions and skin care regimes. This meant that staff may not always have responded appropriately to the needs of people who used this service.

Is the service well-led?

Although a new manager had recently been appointed at the home, this service has been without a registered manager since October 2013.

The staff we spoke with told us that they had noted improvements to the home in general, since the appointment of the new manager. They told us that a lot of different managers had recently been in the home, trying to update records and make improvements to the service, but this had resulted in some confusion and records becoming 'mis-ordered.'

The service had carried out some quality assurance checks. The systems in place were not effective and had not identified continuing deficiencies in safety and quality of the service provided. Effective improvement plans had not been put in place and staff were unsure about their roles and responsibilities. The provider had told us of their 'need to educate staff to improve their understanding.'

Our inspection team was made up of an inspector and a pharmacist inspector. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

As part of this inspection we spoke with three people who used the service, the manager, four care staff and received comments from three relatives. We reviewed records relating to the management of the home, which included, four care plans, daily care records, medication administration records and a sample of the policies and procedures in place at the home. We also carried out a short observational framework inspection (SOFI). This is a 'tool' designed to help inspectors record their observations during an inspection of a service, particularly where people have cognitive or communication impairments and cannot verbally give their opinions of the service they receive.

This is a summary of what we found.

Is the service safe?

During our visit to the home we spent time observing staff supporting some of the people that used this service. We saw examples of very good care given by care staff, particularly when using moving and handling equipment. We noted that assistance was given appropriately and safely. Staff explained the use of equipment and the procedures. This helped to reduce any anxieties service users might have had about the use of this type of equipment.

One person we spoke to told us how staff assisted them with their mobility and used handling equipment. They said that staff explained everything to them at every stage. They added, 'The staff are very good, I feel very safe with them.'

Records showed that decisions had been made about the end of life care for some of the people who used this service. Records did not include how or why these decisions had been made. It was impossible to tell whether these arrangements had been made with the person's consent and in their best interests.

We spoke to the manager about their responsibilities and the requirements of the Mental Capacity Act 2005 with regard to these types of decisions.

We found that the home was not clean, in particular the bathrooms, toilets and shower rooms. This compromised the health and welfare of people who lived and worked at the home.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage them. We looked at care plans for managing medication in detail for six people. All of these were inadequate and had not provided care workers with appropriate guidance on the management of medicines or medical conditions.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs, involving people in the planning of their care and ensuring the welfare and safety of people who use the service.

Is the service effective?

We found that people who used this service had received an assessment of their care and support needs but these had not been kept up to date. Improvements were also needed to effectively assess and manage the risks associated with poor nutrition.

Care plan summaries provided useful information about care needs "at a glance" for care staff and for use in the event of a service user needing transfer to hospital. These documents did not consistently include sufficiently detailed and accurate information.

We observed that people who used this service all appeared well groomed and cared for. The people we spoke to during our visit to the home told us that they were satisfied with the care and support they received. We did not receive any complaints about the care and support people received during our visit.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs, involving people in the planning of their care and ensuring the welfare and safety of people who use the service.

Is the service caring?

The people we spoke to during our visit to the service told us that they were satisfied with the home and the service they received.

We observed that staff were caring, attentive and treated people with respect; people were addressed by their preferred name. We heard staff explaining procedures to people during moving and handling transfers and checking that people had everything they needed to hand.

However, we found that care plans and risk assessments, although reviewed monthly, had not been updated as people's care and support needs changed. This meant that people were placed at risk of receiving inappropriate and unsafe care.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to keeping proper and accurate records to help ensure the welfare and safety of people who use the service.

Is the service responsive?

We looked at records from staff meetings and staff surveys. We noted that staff had recently raised concerns about people 'missing' breakfast or being offered lunch too close to their breakfast because the service user had chosen to stay in bed late. We noted that this was something the manager was going to look at.

We were told that care workers and the manager met weekly to share information and concerns about people including medicines issues. We saw a recent concern about the increasing need for a 'when required' medicine for one person had been discussed. This was managed well and we saw that the person's doctor had been contacted for a medication review.

The provider had a complaints policy in place. We found that the records relating to complaints were not kept confidential to the individual raising the complaint. Additionally, they did not provide sufficient details as to the nature of the complaint, the progress of any investigation or the status of the person complaining.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.

Is the service well led?

Staff told us that they felt well supported by the management at the home. One person said, 'We can always speak to the manager. She listens to what I say I don't have any issues with the management.'

We found that staff were able to attend regular meetings with the management team at the home. We looked at some of the notes kept from this type of meeting. We noted that the manager had listened to what staff had to say and was trying to address concerns and issues raised by staff. For example staff morale had been low, but this was improving now because more staff had been employed and staff now had their breaks.

Although staff had raised concerns with us prior to our inspection, we did not find anything to support the concerns that had been raised. Staff did not raise any further concerns with us either during or after our visit to the home.

We saw that the provider had systems in place for monitoring and auditing the quality of service provided and saw that audits had been carried out to check the quality of various aspects of the home and service. For example the management of medicines, care planning, risk assessment and infection control. However, these checks had not been carried out robustly or effectively. This meant that people were at risk of receiving unsafe and inappropriate care.

The home does not currently have a registered manager.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.

They all told us that they were happy at the home and pleased with the support they received.

One person told us, 'The home is different to what I thought it would be like. I was dreading it really but everything has been OK so far. You hear such awful things about care homes. The staff are very nice and have answered any queries I have had. There are no rules and I can do as I please really.'

Another person said that they were able to go out and continue with their usual community activities. They told us that staff had been, 'Very helpful but don't take over. I can join in things at the home if I like or I can go to my room whenever I like too.'

We were told by one service user that they were 'Happy to be here for the rest of my life. I am delighted with the treatment I receive. Staff are 99% helpful and understanding.'

Two of the people we spoke to told us that they had lived in 'other homes.' Both of them told us that Harriets was 'much better.' One of them told us that the staff 'treated' them 'nicely here' and the other person said, 'The staff can't do enough for me, it is very homely and friendly here.'

We found that the sample of care plans we looked at showed that people were encouraged to do things for themselves wherever possible. Care plans had been discussed and agreed with people and, where appropriate, their relatives had been involved too.

We saw that prospective care staff had undergone the necessary checks to help ensure they were of good character and had the necessary skills and experience for their role.

We checked the information we held about this service. We had received some anonymous concerns about this home, but when we checked them out during our inspection, we found that the allegations could not be upheld.

We asked social workers and commissioners from Cumbria County Council if they had any concerns about this home. We did not receive any concerns or comments from them.